基于动脉自旋标记技术的麻痹性痴呆患者脑血流量特点及其与认知障碍相关性

目的探讨麻痹性痴呆（GPI）患者脑血流量（CBF）特点及其与认知障碍的相关性。 方法纳入2018年1月至2019年12月于首都医科大学附属北京地坛医院就诊的GPI患者18例和健康体检者18例（健康对照组），采用蒙特利尔认知评估量表评定认知功能。采用磁共振动脉自旋标记技术扫描评估其各个脑区CBF，并进一步应用Spearman相关分析CBF异常区域与认知功能的相关性。 结果GPI患者蒙特利尔认知评估量表评分低于健康对照组（16.00 ± 7.19）vs. （27.90 ± 1.21）：t =－7.853、P < 0.001）]。18例GPI患者中，头颅MRI正常5例，脑白质病变1例，脑萎缩9例，3例患者同时存在脑萎缩和脑白质病变。健康对照组头颅MRI均未见异常。GPI患者脑13、14、28、37、38、41、42、43、44、46、48、49、50、51、52、69、70、77、78、83、84、88、109、117、165、166、167、168、169、177、178、179、187、188、211、212、213、214、215、216、219、223、227、237和238区CBF显著高于健康对照组（P均< 0.001）。GPI患者认知障碍中的注意力障碍与脑69、70、77、78、166和168区CBF异常有一定的负相关性（r =－0.476、P = 0.046，r =－0.487、P = 0.034，r =－0.604、P = 0.008，r = －0.545、P = 0.019，r =－0.544、P = 0.02，r =－0.522、P = 0.026）。 结论GPI患者存在全脑血流量升高。GPI患者认知功能障碍中的注意力障碍可能与局部脑区血流量升高有一定相关性。局部CBF越高，注意力障碍越严重。这可能也是GPI发病机制之一。

Characteristics of cerebral blood flow and its correlation with cognitive impairment in patients with general paralysis of the insane evaluated by arterial spin labeling

ObjectiveTo investigate the characteristics and relationship between cerebral blood flow (CBF) and cognitive impairment in patients with general paralysis of the insane (GPI). MethodsTotal of 18 patients with GPI (GPI group) and eighteen healthy controls (HC group) were enrolled from January 2018 to December 2019 in Beijing Ditan Hospital, Capital Medical University. The cognitive function was assessed by montreal cognitive assessment (MoCA). The cerebral blood flow was evaluated by arterial spin labeling, and the relationship between cerebral blood flow and cognitive function was analyzed by Spearman correlation analysis. ResultsThe MoCA score of patients with GPI was significantly lower than that of HC group (16.00 ± 7.19) vs. (27.90 ± 1.21): t = -7.853, P < 0.001]. Among GPI group, 5 cases had normal brain MRI, 1 case had white matter lesions, 9 cases had brain atrophy, and 3 cases had brain atrophy and white matter lesions at the same time. No abnormality head MRI was found in HC group. The cerebral blood flow in 13, 14, 28, 37, 38, 41, 42, 43, 44, 46, 48, 49, 50, 51, 52, 69, 70, 77, 78, 83, 84, 88, 109, 117, 165, 166, 167, 168, 169, 177, 178, 179, 187, 188, 211, 212, 213, 214, 215, 216, 219, 223, 227, 237 and 238 brain regions in the patients with GPI were significantly higher than those of HC group (all P < 0.001). There were negative correlations between lack of concentration and high CBF in 69, 70, 77, 78, 166 and 168 brain regions (r = -0.476, P = 0.046; r =-0.487, P = 0.034; r =-0.604, P = 0.008; r =-0.545, P = 0.019; r =-0.544, P = 0.02; r =-0.522, P = 0.026). ConclusionsThe whole brain blood flow increased in patients with GPI. Concentration may be related to the increase of regional CBF; the higher the regional CBF, the more severe the attention disorder. This may be one of the pathogenesis of GPI.